Nys Subcontractor Agreement

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					                                                       CITY OF NEW YORK
                                           SUBCONTRACTOR APPROVAL FORM
                                  Column on left indicates whom that section is to be completed by.
                                                     PRIME CONTRACT INFORMATION
                  Agency:                                                  Unit/Div:
                  FMS Contract No.:                                PIN:
                  Contract Value: $                                Registration Date:
AGENCY




                  Contract Description:
                  Contract Subject to a Project Labor Agreement (PLA)
                                                  PRIME CONTRACTOR IDENTIFICATION
                  Name:
                  Phone:                                                   Fax:
                  Address:                                                 City:                          State/Zip:
                  EIN/SSN:                                                 E-Mail:
                                                     SUBCONTRACTOR INFORMATION
                  Name:
                  Phone:                                                   Fax:
                  Address:                                                 City:                          State/Zip:
                  EIN/SSN:                                                 E-Mail:
PRIME CONTACTOR




                  Subcontract Description:

                  Approx Subcontract Value: $                             Approx Start Date __/__/__ Approx End Date __/__/__
                  Subcontractor Signed Letter of Assent         (if Prime Contract is subject to a Project Labor Agreement)
                  Subcontractor is DSBS-certified as: M/WBE            EBE      or LBE       (check all that apply & note status below)
                  YES                          Application Pending                Intends to Apply                 NO
                  Subcontractor Prevailing Wage or Living Wage Statement (if applicable)
                  Prime Contractor Certification: I hereby affirm that the information supplied is true and correct.
                  Signature                                                                       Title
                  Print Name                                                                      Date

                                                    AGENCY PRELIMINARY REVIEW
                                                PLEASE SEE PAGE 2 FOR INSTRUCTIONS
AGENCY




                  Agency Preliminary Review Completed By:                                                     Date

                  1. VENDEX         2. Employment          3. References         4. PLA        5. Apprenticeship       6. Licenses

                                                     PRIME CONTRACTOR RESPONSE
CONTACTOR




                  For each of the boxes checked in the agency preliminary response above, I have informed the Subcontractor of
  PRIME




                  all relevant requirements and provided all requested documentation.

                  Initials:                                                      Date

                                                         AGENCY FINAL RESPONSE
AGENCY




                  Final Agency Approval:             Granted        Denied

                  Signature:                                                   Date




                                                                                          MOCS Subcontractor Approval Form (April 2010)
                                      CITY OF NEW YORK
                                SUBCONTRACTOR APPROVAL FORM
                                                   Page 2
                            Prime Vendor Preliminary Review Follow-up Instructions

After completing the Preliminary Review, the agency will mark, on Page 1, the box for any item requiring
follow-up and return the form the to the Prime Vendor. The Prime Vendor should follow the instructions
below for each of the boxes checked in the Agency Preliminary Review on Page 1, and return the form to
the agency with any required documentation.

   1. VENDEX
       If Box 1 (VENDEX) is checked, the agency has granted preliminary approval, and determined that
       the subcontractor is required to file VENDEX Questionnaires with the Mayor's Office of Contract
       Services. A VENDEX Vendor Questionnaire and Principal Questionnaire must be filed where the
       subcontract dollar amount is ≥ $100,000 or where the aggregate business with the City is ≥
       $100,000 during the preceding twelve months. The VENDEX Questionnaires and Guide can be
       downloaded from http://www.nyc.gov/html/selltonyc/html/tocvendex.html.
   2. Employment
       If Box 2 (Employment) is checked, the subcontractor must complete a Division of Labor Services
       (DLS) Construction Employment Report. A subcontractor selected to perform work on a
       construction project funded or assisted by the City of New York must complete a DLS Construction
       Employment Report if the subcontract dollar amount > $750,000. For construction projects funded
       in whole or in part by the federal government, a DLS Construction Employment Report must be
       completed if the proposed subcontract value > $10,000. For non-construction goods/services
       subcontracts > $100,000, employment reports are required for any subcontractor with > 50
       employees, and a certificate is required for those with fewer employees.

   3. References
       If Box 3 (References) is checked, you as the prime contractor must provide references with respect
       to the subcontractor’s ability to perform, consisting of a list of three completed comparable projects.
       References shall include a full description/location of each project, scope of work, value of project,
       and the names and phone numbers of owners, architect or engineer who supervised the work.
       Please attach your documentation to your response.

   4. PLA
       If Box 4 (PLA) is checked, you as the prime contractor must obtain signed Letter of Assent from the
       subcontractor which demonstrates that the subcontractor agrees to the terms of the PLA. Please
       attach the subcontractor’s signed Letter of Assent to your response.

   5. Apprenticeship
       If Box 5 (Apprenticeship) is checked, you as the prime contractor must provide the agency with proof
       that the subcontractor maintains an apprenticeship agreement appropriate for the scope of work to
       be performed, that the apprenticeship agreement has been registered with and approved by the
       New York State Commission of Labor, and that the program has three years of current, successful
       experience in providing career opportunities.
   6. Licenses
       If Box 6 (Licenses) is checked, you as the prime contractor must document that the subcontractor
       has all required licenses. Please attach your documentation to your response.


                                                                      MOCS Subcontractor Approval Form (April 2010)

				
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